Late Complications and Quality of Life after Reduced-Intensity Conditioning Allogeneic Stem Cell Transplantation

Abstract

Late complications (LC) and quality of life (QOL) were analyzed in 110 adult patients who underwent reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT) and were alive for more than 2 years after allo-SCT. Overall survival of these patients was 93% (95% confidence interval [CI], 88% to 99%) and 81% (95% CI, 71% to 94%) at 5 and 10 years, respectively. The primary cause of death was a recurrence of primary malignancy. With a median follow-up of 4.6 years (range, 2 to 12.1), chronic graft-versus-host disease (cGVHD) was the most prevalent late effect, with a cumulative incidence of 66% (95% CI, 57% to 74%) at 10 years. Cardiovascular complications were the most prevalent LC with a cumulative incidence of 47% (95% CI, 35% to 59%), followed by pulmonary complications with a cumulative incidence of 33% (95% CI, 21% to 46%) and renal impairment with a cumulative incidence of 34% (95% CI, 25% to 43%) at 10 years. Secondary malignancies occurred with a cumulative incidence of 11% (95% CI, 5% to 20%) at 10 years. In this series, 61 patients (55%) responded to QOL survey. With the use of European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Functional Assessment of Cancer Therapy-Bone Marrow Transplant questionnaires, most of the patients reported good to excellent QOL and patients with cGVHD had significantly lower QOL than patients without cGVHD. In conclusion, QOL after RIC is comparable to that seen after myeloablative conditioning, while the natural history of LC after RIC appears to be different from that described in the standard myeloablative setting, warranting further research in this field.

Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017

“…We found aGVHD was an independent predictor for shorter OS and PFS, while cGVHD might prolong survival due to an accompanying GvM effect and can thus in a mild form be regarded as an advantageous feature. However, some studies have reported cGVHD was also related to chronic diarrhea, appetite loss and inferior QOL [ 90 , 96 , 97 ], and was the most important cause of TRM. Novel strategies for acute and chronic GVHD prevention need to be explored in the setting of allografting for MM.…”

Myeloma patients' experiences of haematopoietic stem cell transplant: A qualitative thematic synthesis

“…It is likely that patients do not discuss cognitive impairment as they are not asked about it by staff as a side effect of treatment (Portora et al, 2010). Nurses should ask patients regularly about their memory and any challenges they may be experiencing to their concentration and recall, It is well known that neurocognitive deficits (referred to as "chemo brain"), have a huge impact on allogenic transplantation survivors' daily activities and a challenge for those who return to work (Inamoto, & Lee 2017;Clavert et al, 2017). Our understanding of neurocognitive effects following autologous transplantation is also of concern.…”

<p>Optimal Delivery of Follow-Up Care After Allogeneic Hematopoietic Stem-Cell Transplant: Improving Patient Outcomes with a Multidisciplinary Approach</p>

“…Chronic kidney disease (CKD) is described in about 20-60% of patients. [119][120][121][122] Al-Hazzouri et al reported older age, hypertension, poor pre-transplant kidney function, diagnosis of multiple myeloma (MM), and use of CNIs for GvHD as risk factors for CKD. 123 Other authors reported that fludarabine administration was significantly associated with chronic renal impairment.…”